2013年-世界发展银行全球_The_Long_March_to_Universal_Coverage___Lessons_from_China_58页_1mb

Summary of "The Long March to Universal Coverage: Lessons from China"

Core Content

This document outlines the evolution and challenges of China's Health Coverage to the Poor (HCP) initiatives, focusing on the expansion of health insurance programs and the establishment of a health safety net for the poorest populations. It is part of the World Bank's Universal Health Coverage Studies Series (UNICO Study Series), which aims to provide insights and operational tools for countries seeking to implement UHC policies.

Main Objectives of the Study

• To analyze the implementation of HCP in China, particularly for the poor.
• To identify key dilemmas and challenges in achieving universal health coverage.
• To offer lessons and recommendations for future health policy development.

Key Policies and Programs

China has implemented several health insurance programs aimed at expanding coverage:

1. Urban Employee Basic Medical Insurance (UEBMI): A mandatory scheme for urban formal sector workers, with contributions from both employers and employees. It includes a social pooling fund and individual Medical Savings Accounts (MSAs).
2. New Rural Cooperative Medical Scheme (NRCMS): A voluntary program for rural residents, heavily subsidized by the government. It was piloted in 2003 and expanded during the 11th Five-Year Plan.
3. Urban Resident Basic Medical Insurance (URBMI): A voluntary scheme for urban non-workers, launched in 2007. It covers students, children, the elderly, and the unemployed.
4. Medical Assistance (MA) Program: A government-run safety net program that provides financial support to the poorest of the poor, supplementing the coverage of NRCMS and URBMI.

Challenges in HCP Implementation

1. Financing and Sustainability

• The government has invested heavily in HCP, but long-term sustainability is a concern, especially if GDP growth slows.
• The out-of-pocket (OOP) payment ratio in China (37% in 2010) is still higher than the average of upper-middle-income countries (33.4%).
• The growth in total health expenditure (THE) has not been matched by improvements in patient outcomes, suggesting inefficiencies in the system.

2. Institutional Arrangements

• The implementation of HCP involves coordination across 15 national ministries.
• The institutional framework is complex, with different ministries overseeing various aspects of the health system.

3. Targeting and Benefits Packages

• The benefits packages of NRCMS and URBMI are relatively shallow, with limited coverage for outpatient services.
• The MA program has a limited role in financial protection for the poor, as only a small proportion of enrolled individuals receive assistance.

4. Supply Constraints and Information Technology

• Public hospitals face challenges in providing efficient and effective care.
• The fee-for-service (FFS) system has led to rising hospital costs without corresponding improvements in health outcomes.
• Information technology infrastructure is still underdeveloped, limiting the ability to monitor and improve service delivery.

Key Findings

• Coverage Expansion: By 2011, the three major health insurance schemes (UEBMI, NRCMS, URBMI) covered 95% of the population, with the MA program providing additional support to the poorest.
• Financial Protection: Despite expansion, financial protection for households remains inadequate, with a shallow benefits package and limited reimbursement rates.
• Efficiency and Equity: The system has not fully addressed the issue of equity, with disparities in benefits and coverage between urban and rural areas.
• Need for Reform: There is a need for structural reforms, including improving risk pooling, adjusting payment mechanisms, and enhancing the comprehensiveness of benefits.

Next Steps for HCP

• Integration of different schemes to reduce inequality and improve cross-subsidization.
• Strengthening the MA program to ensure it effectively supports the poorest.
• Enhancing the efficiency and quality of care through better regulation and resource distribution.
• Improving information technology and data systems to monitor and improve service delivery.

Conclusion

The document concludes that while China has made significant progress in expanding health coverage, especially for the poor, there are still major challenges in ensuring financial protection, improving service quality, and achieving equitable access. The UNICO Study Series aims to support ongoing efforts to address these challenges and move toward universal health coverage.